The Phenotype of Endothelium in Children with ALL Might Be a Predictor of the Outcome – a Pilot Study

Activation of endothelium has been demonstrated to be associated with an increased risk of mortality in severe diseases. In this study we hypothesize that ALL might be also associated with endothelial dysfunction (ED) and that children with concomitant ED might be at higher risk for death.

N=18 children at age of 4–18 years with ALL treated with the ALLIC protocol were investigated. Plasma levels of markers of ED (VCAM-1, ICAM-1, E-selectin, P-selectin and PAI-1), lipid peroxidation (malonyldialdehyde – MDA), angiogenesis (VEGF) as well as routine blood tests were analyzed at baseline – the day of diagnosis of ALL, next during the 33^rd day of the protocol (steroid therapy, evaluation of remission) and subsequently at the 78^th day of therapy (beginning of the protocol M). The control group constituted of N=15, age-matched healthy children.

Children with ALL were characterized with significantly worse kidney and liver function at baseline as compared to the control. Similarly, the fasting glycemia was higher in the investigated group. Markers of endothelial proagreagattory and procoagulative function (P-selectin and PAI-1) were similar in both groups at baseline. However, vascular inflammation was significantly more pronounced in children with ALL at baseline as compared to the healthy control (ICAM-1= 467.1±72.8 vs. 206.3±21.7 ng/ml, p<0.05). High baseline plasma level of E-selectin and VEGF (as compared to the healthy control) were positive predictors for death in children with ALL (E-selectin: 56.1±10.9 vs. 28.1±10.0 ng/ml, respectively; VEGF: 366.1±61.6 pg/ml vs. 190.1±71.4 pg/ml, respectively, p<0.05).

Endothelial inflammatory activation is a common phenomenon in children with ALL. High baseline level of VEGF and E-selectin are associated with higher mortality in ALL.

No relevant conflicts of interest to declare.